Breast-conserving therapy and modified radical mastectomy for primary breast carcinoma:a matched comparative study

Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886） （P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900） （P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.

Fifty-Year-Follow-up Results Compared with Shorter Follow-up of Breast Cancer Patients Undergoing Radical Mastectomy with or without Adjuvant Radiotherapy

Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast cancer, second cancer, and benign diseases. Methods: 763 patients treated for breast cancer between February 1953 and September 1976, were followed up until December 2014. They were divided into two cohorts;earlier cohort exclusively underwent radical mastectomy plus adjuvant radiotherapy, while later cohort had radical mastectomy alone. Assuming that in all patients follow-up was terminated at 50 or 25 years after diagnosis, likelihood ratio test and stratified Log-rank tests were performed to evaluate the differences in cure rate and overall survival between the two cohorts. Results: During the 50 years, radical mastectomy alone compared with radical mastectomy plus adjuvant radiotherapy is associated with a significantly higher cure rate, and higher survivals regardless of whether the death was from breast cancer, second cancer, benign causes or any causes. However, if follow-up information is limited to 25 years, the advantage of radical mastectomy alone is partly offset and the survival difference between the two cohorts becomes less significant. Conclusion: Radiotherapy to breast cancer may adversely affect not only mortality from breast cancer, but mortalities unrelated to breast cancer. Since such deaths occur later, they may fail to be detected unless follow-up is long enough. Thus, deleterious effects of radiotherapy may be underestimated. Exceedingly long follow-up is required to accurately estimate the cure rate and the long-term effect of radiotherapy.

Effect of epidural block combined intravenous general anesthesia stress on the stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy

Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function.

Clinical outcome analysis of 98 elderly women with early-stage breast cancer undergoing modified radical mastectomy or simple mastectomy

Objective: The aim of our study was to analyze the clinical results and prognosis for early elderly patients after surgery and to explore the rational treatment. Methods: Between January 1992 and December 2008, 98 early elderly breast cancer patients aged ≥ 65 years were treated with surgery, of which 52 patients received modified radical mastectomy and 46 patients received simple mastectomy. Results: Sixty-four (65.3%) patients had comorbidities including coronary heart disease, hypertension, diabetes, etc. After a median follow up of 56 months (21 to 280 months), the 5-year cumulative survival rate of breast modified radical mastectomy group and mastectomy group were 84.0% and 82.7%, separately (P = 0.653). The 5-year recurrence rate were 3.8% and 8.1%, separately (P = 0.504). Conclusion: The simple mastectomy is suitable for the treatment of early elderly breast cancer patients for its lower complication and recurrence rate. Early old women with breast cancer may be safely treated by simple mastectomy. Our findings suggest that modified radical mastectomy does not significantly increase the overall survival.

Combined thoracic paravertebral block and interscalene brachial plexus block for modified radical mastectomy:A case report

BACKGROUND Modified radical mastectomy(MRM)is the most common surgical treatment for breast cancer.General anesthesia poses a challenge in fragile MRM patients,including cardiovascular instability,insufficient postoperative pain control,nausea and vomiting.Thoracic paravertebral block(TPVB)is adequate for simple mastectomy,but its combination with interscalene brachial plexus block(IBPB)has not yet been proved to be an effective anesthesia method for MRM.CASE SUMMARY We describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities.An ultrasound-guided TPVB was placed at T2-T3 and T5-T6,and combined with IBPB,with administration of 10,15 and 5 mL of 0.5%ropivacaine,respectively.A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min.Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery.None of the patients required additional narcotics,vasopressors,or conversion to general anesthesia.The maximum pain score was 2 on an 11-point numerical rating scale.Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis.CONCLUSION This case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM,providing good postoperative analgesia.

Effects of dezocine on cardiovascular response, stress response and cellular immune function before anesthesia induction in radical mastectomy for breast cancer

Objective: To investigate the effects of dezocine on cardiovascular response, stress response and cellular immune function before anesthesia induction in radical mastectomy for breast cancer. Methods: From January 2014 to January 2018, 220 patients with breast cancer undergoing modified radical mastectomy were randomly divided into observation group (110 cases) and control group (110 cases). The observation group was given dezocine before induction of anesthesia, while the control group was given the same amount of Sodium Chloride Injection. Heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), aldosterone (ALD), renin (REN), cortisol (Cor), angiotensin Ⅱ (Ang-Ⅱ) and the level of T cell subsets at 5 time points before anesthesia (T1), 2 h after operation (T2), 10 hours (T3), 24 h (T4) and 48 h (T5) after operation were compared between the two groups. Results:There was no significant difference in HR and MAP between the two groups before anesthesia (30 min). HR and MAP of the two groups were higher at 2 h after operation and 10 h after operation than before, and the HR and MAP of the control group were higher than those of the observation group. There was no significant difference in ALD, REN, Cor and Ang-Ⅱ between the two groups at 30 min before anesthesia and 48 h after operation. ALD, REN, Cor and Ang-Ⅱ in the two groups at 2 h after operation and 10 h, 24 h after operation were higher than those at the 30 min before anesthesia, and ALD, REN, Cor and Ang-Ⅱ in the control group were higher than those in the observation group. There was no significant difference in CD3+, CD4+, CD4+/ CD8+ between the two groups at 30 min before anesthesia and 48 h after operation. CD3+, CD4+, CD4+/CD8+ in the two groups at 2 h after operation and 10 h, 24 h after operation were lower than those at the 30 min before anesthesia, and CD3+, CD4+, CD4+/CD8+ in the control group were lower than those in the observation group. Conclusion: Dezocine before anesthesia induction in radical mastectomy can effectively reduce cardiovascular response and stress response, and play a protective role in cellular immune function.

Effects of ultrasound-guided thoracic paravertebral block combined with general anesthesia on the secretion of pain-related mediators after modified radical mastectomy

Objective: To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anesthesia on the secretion of pain-related mediators after modified radical mastectomy. Methods: A total of 108 patients with breast cancer who were treated with modified radical mastectomy in this hospital between July 2015 and February 2017 were divided into the control group (n=54) and paravertebral block group (n=54) by random number table. Control group received routine general anesthesia, and paravertebral block group received ultrasound-guided thoracic paravertebral block combined with general anesthesia. The differences in serum levels of pain mediators, inflammatory factors and stress hormones were compared between the two groups of patients immediately after surgery (T0), 6h after surgery (T1), 12h after surgery (T2) and 24h after surgery (T3). Results: At T0, there was no statistically significant difference in serum levels of pain mediators, inflammatory factors and stress hormones between the two groups. At T1, T2 and T3, serum pain mediators NPY, PGE2 and 5-HT levels of paravertebral block group were lower than those of control group;serum inflammatory factors IL-1, IL-6, TNF-α and MCP-1 levels were lower than those of control group;serum stress hormones ACTH, Cor, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion: ultrasound-guided thoracic paravertebral block combined with general anesthesia can effectively reduce the release of pain mediators and relieve the systemic inflammatory stress response after modified radical mastectomy.

Effect of ultrasound-guided serratus anterior plane block on the pain, inflammation and oxidation after radical mastectomy

Objective:To study the effect of ultrasound-guided serratus anterior plane block on the pain, inflammation and oxidation after radical mastectomy.Methods: Patients who underwent radical mastectomy in Qinghai Provincial People's Hospital between March 2015 and December 2017 were selected as the research subjects and randomly divided into the experimental group who accepted ultrasound-guided serratus anterior plane block combined with general anesthesia and the control group who accepted general anesthesia. The pain mediators, inflammatory molecules and oxidative stress molecules were measured before surgery and 3 d after surgery.Results: Compared with those of same group before surgery, serum NPY, SP, PGE2, CGRP, IL-1β, IL-18, TNF-α, MDA and 8-iso-PGF2 levels as well as peripheral blood NF-κB, NLRP3, NOX4 and MPO expression intensity of both groups of patients were increasing whereas serum SOD levels were decreasing after surgery, and serum NPY, SP, PGE2, CGRP, IL-1β, IL-18, TNF-α, MDA and 8-iso-PGF2 levels as well as peripheral blood NF-κB, NLRP3, NOX4 and MPO expression intensity of experimental group after surgery were lower than those of control group whereas serum SOD level was higher than that of control group.Conclusion:Ultrasound-guided serratus anterior plane block has significant inhibitory effect on the pain, inflammation and oxidation degree after radical mastectomy.

Effect of Breast Conserving Sentinel Lymph Node Biopsy(SLNB)and Modified Radical Mastectomy on Patients with Early Breast Cancer

Objective:To study the clinical effect of breast conserving combined with sentinel lymph node biopsy and modified radical mastectomy in patients with early breast cancer.Methods:Female patients with early breast cancer in clinical stage I and II were selected as the main objects of this study,the study period started from July 2017 to July 2020.In the breast conserving and sentinel lymph node biopsy patients,50 cases were randomly selected as the experimental group;50 cases in the modified radical mastectomy patients were randomly selected as the control group.The clinical intervention effect of the two groups was analyzed.Results:the perioperative indexes of the experimental group were shorter than those of the control group,the patients recovered faster,the incidence of complications in the experimental group was lower,and the quality of life scores of the experimental group were significantly higher than those of the control group,and the difference was statistically significant,the intervention effect of the experimental group was also better.Conclusion:The application of breast conserving and sentinel lymph node biopsy in the treatment of early breast cancer can promote the recovery of patients,shorten the operation time and reduce the rate of complications,which has significant clinical significance.

Effect of dexmedetomidine on Th1/Th2 cytokine and immune function in patients undergoing radical mastectomy

Objective: To investigate the effect of dexmedetomidine on Th1/Th2 cytokines and immune function in patients with breast cancer after radical mastectomy. Methods: In our hospital from July 2016 to July 2017 undergoing radical mastectomy for breast cancer were studied in 79 patients, were randomly divided into observation group and control group. Two groups of patients with routine preoperative preparation, monitoring blood pressure, electrocardiogram, heart rate, pulse, oxygen saturation, establish vein channel, using propofol, remifentanil, vecuronium induced anesthesia, observation group before induction of anesthesia, dexmedetomidine 1 μg/kg, 10 min after infusion, followed by 0.5 μg/kg/h continuous infusion to the end of the operation, the control group with normal saline continuous infusion till the end of the operation. Two groups of patients before induction of anesthesia (T0), at the end of operation (T1), 6 h after operation (T2), 24 h after operation (T3), 72 h after operation (T4) from peripheral venous blood determination of interleukin-2 by ELISA method (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10) and interferon gamma (IFN-γ), calculated IFN-γ/IL-4 in T0, T2, T3, T4from peripheral blood. CD3+, CD4+, CD8+, NK cells were determined by flow cytometry and CD4+/CD8+ were calculated. Results: Two groups of IL-2 and IFN- in T1, T2, T3gamma, T4is higher than T0, IL-10 less than T0, and the observation group IFN-γ/IL-4 is higher than T0, the control group was lower than that of T0when compared with T0significant difference, 2 in group IL-4 had no obvious changes were observed in group IL-2;IFN-γ, IFN-γ/IL-4 in T1, T2, T3, T4higher than the control group, IL-10 was lower than the control group, significant difference between the 2 groups. CD3+, CD4+, CD4+/CD8+, NK cells in T2group was lower than that of T0, T3, and CD8+ had no obvious change, compared with T0significant difference;the observation group CD3+, CD4+, CD4+/CD8+, T2, T3in NK cells was higher than the control group, significant difference between the 2 groups. Conclusion: Dexmedetomidine can inhibit the stress response during the perioperative period of radical mastectomy, correct the balance disorder of Th1/Th2, improve the level of T lymphocyte subsets, and exert better immune protection function.

Observation on the Therapeutic Effects of Qingre Shengji Ointment(清热生肌膏)on Acute Radiation Dermatitis After Modified Radical Mastectomy

Objective:To observe the curative effect of Qingre Shengji Ointment(清热生肌膏)on acute radiation dermatitis caused by radiotherapy after modified radical mastectomy.Methods:100 patients with radiotherapy after modified radical mastectomy in our hospital from June 2019 to December 2020 were randomly divided into treatment group and control group,with 50 cases in each group.The treatment group was given Qingre Shengji Ointment(清热生肌膏)on the basis of routine nursing,and the intervention began until one week after radiotherapy,while the control group was given routine nursing.Observe and record the occurrence time of acute radiation dermatitis,the degree of acute radiation dermatitis,changes of skin erythema,pruritus,pain,changes of interleukin-6(IL-6)and curative effect were evaluated.The degree of dermatitis was evaluated by RTOG grading standard,the erythema was evaluated by TCM symptom score,and pruritus and pain were evaluated by visual analogue scale(VAS).Blood routine,liver and kidney function,electrocardiogram and other safety indicators and adverse reactions were recorded before and after the study.Results:The time of acute radiation dermatitis was 6-11 days(median 8 days)in the treatment group and 8-14 days(median 10 days)in the control group(P<0.01).The degree and probability of acute radiation dermatitis in the treatment group were 82%(41/50)in grade I,16%(8/50)in grade II and 2%(1/50)in grade III.The degree and probability of acute radiation dermatitis in the control group were 54%(27/50)in grade I,40%(20/50)in grade II and 6%(3/50)in grade III(P<0.05).The highest TCM symptom score of skin erythema in the treatment group was lower than that in the control group(P<0.01).The results of generalized estimation equation show that,The VAS scores of pruritus and pain were(1.34±0.01)and(2.08±0.02)(Waldχ^(2)=1198.123,P<0.01)in the treatment group and(2.08±1.74)(Wald^(2)=1547.804,P<0.01)in the control group,respectively.Compared with the control group,the VAS scores of pruritus and pain were(1.14±0.01)and(2.08±1.74)(Wald^(2)=1547.804,P<0.01)in the treatment group.After observation,the curative effect of the treatment group was better than that of the control group(P<0.05),and the subjective symptoms of patients were obviously improved.After treatment,the level of IL-6 in the treatment group was significantly lower than that before treatment,and was lower than that in the control group(P<0.01).Conclusion:Qingre Shengji Ointment(清热生肌膏)can prevent and treat acute radiation dermatitis to some extent,and its mechanism may be to inhibit the release of inflammatory cytokines,reduce the degree of dermatitis,improve the quality of life of patients,and its safety is good.VAS score can subjectively evaluate the changes of itching and pain,and it is easy to use,so it is worthy of clinical application.

乳腺癌综合治疗的疗效随访

目的观察经免疫组织化学分型的乳腺癌综合治疗疗效,为临床治疗提供参考。方法随访山西省肿瘤医院2010年1月至2012年12月治疗的1240例乳腺癌患者,其中导管型883例;人表皮生长因子受体-2(HER-2)型260例;三阴性乳腺癌(TNBC)97例。保乳术(BCS)或术前新辅助化疗,或术后放化疗的共275例;改良根治术(IRM)和术前新辅助化疗,或术后放化疗的共965例。BCS和IRM后,均行术后常规患侧全乳房、全胸壁调强放疗(IMRT)和锁骨淋巴引流区放疗,DT约50 Gy。腋窝淋巴转移阳性者,补照腋窝区DT 60~70 Gy。雌激素受体(ER)阳性者,行辅助性内分泌治疗。HER-2阳性者,加用曲妥珠单克隆抗体靶向药物治疗。结果BCS和IRM患者的五年生存率分别是81.8%和78.2%(P>0.05),其中腋窝淋巴结无转移者为91.8%;1~3个淋巴结转移者为74.0%;4个以上转移者为63.0%。4个以上淋巴结转移者和无转移者五年生存率差异具有统计学意义(P<0.01)。导管型五年生存率为98.0%;HER-2型为37.7%;TNBC型为17.5%。结论导管型对内分泌治疗敏感,预后最好;HER-2型对抗HER-2靶向药物有效,预后居中;TNBC型具有较强的侵袭性,且对内分泌和靶向药物治疗效果有限,预后最差。免疫组织化学分型和腋窝淋巴结转移数的多少,是影响预后的重要因素之一。

伤害感受水平指数指导瑞芬太尼输注靶浓度对接受乳腺癌根治术患者细胞免疫和缺氧诱导因子-1α的影响

目的探讨伤害感受水平(NOL)指数应用于乳腺癌根治术对患者的细胞免疫和缺氧诱导因子(HIF)-1α的影响。方法招募2022年12月至2023年12月行乳腺癌根治术的80例患者,随机将患者分为观察组和对照组。观察组控制NOL指数在30~50,依此调整瑞芬太尼靶浓度,对照组起始采用瑞芬太尼4 ng/mL靶控输注,依据血流动力学调整瑞芬太尼靶浓度。记录瑞芬太尼平均靶浓度;记录手术前1 d及手术后1 d患者的静脉血CD4^(+)、CD8^(+)以及NK细胞值,测定血清中HIF-1α水平。结果两组患者的麻醉时间、手术时间、术中MAP、HR、丙泊酚靶浓度和术后VAS评分均差异无统计学意义(P>0.05),观察组术中的瑞芬太尼平均靶浓度低于对照组(P<0.05);在术后1 d,观察组的CD4^(+)、CD4^(+)/CD8^(+)、NK细胞值均高于对照组,HIF-1α水平低于对照组(P<0.05)。相比术前1 d,观察组患者在术后1 d的CD4^(+)、CD4^(+)/CD8^(+)较低,HIF-1α水平较高(P<0.05);相比术前1 d,对照组患者在术后1天的CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及NK细胞值较低,HIF-1α水平较高(P<0.05)。结论NOL指数应用于全麻下乳腺癌根治术可以减少术中瑞芬太尼的靶浓度,降低瑞芬太尼对细胞免疫的抑制,保护NK细胞的活性,同时减少HIF-1α升高水平,由此推断对患者肿瘤免疫微环境的影响更小。

乳腺癌改良根治术患者近端肋间臂神经联合前锯肌平面阻滞临床效果观察

目的:探讨乳腺癌改良根治术患者近端肋间臂神经阻滞联合前锯肌平面阻滞(SAPB)的临床效果。方法:选择在全身麻醉下行乳腺癌改良根治术的患者60例,采用随机数字表法分为近端肋间臂神经阻滞联合SAPB组(联合组)和SAPB组(前锯肌组),每组30例。两组分别在全麻诱导后行超声引导下近端肋间臂神经阻滞联合前锯肌平面阻滞和前锯肌平面阻滞。采用视觉模拟评分法(VAS)记录患者术后30 min及2、4、8、24 h疼痛情况。记录术中瑞芬太尼使用总量、术后24 h舒芬太尼使用总量、补救镇痛时间、24 h内补救镇痛率以及不良反应情况。结果:与前锯肌组比较,联合组术后2、8 h的VAS评分降低,术中瑞芬太尼的使用量及术后舒芬太尼的使用量减少,总不良反应率降低,首次补救镇痛时间延长,24 h内补救镇痛率降低(均P<0.05)。结论:与前锯肌平面阻滞相比,近端肋间臂神经阻滞联合前锯肌平面阻滞可以减少围手术期阿片类药物使用,改善乳腺癌改良根治术患者术后镇痛效果。

体素内不相干运动成像联合动态增强MRI评估乳腺癌改良根治术后复发的价值

目的探讨体素内不相干运动成像(IVIM)联合动态对比增强磁共振成像(DCE-MRI)对乳腺癌改良根治术后复发的评估价值。方法采用前瞻性研究,选择拟行改良根治术的乳腺癌患者作为研究对象。所有患者术前均接受IVIM与DCE-MRI检查,检测IVIM参数[单纯水分子扩散系数(D值)、灌注分数(f值)、假性扩散系数(D^(*)值)]与DCE-MRI定量参数[容量转移常数(Ktrans)、血管外细胞外容积分数(Ve)、速率常数(Kep)],实施乳腺癌改良根治术治疗,随访1年,统计随访期间患者复发情况,分析乳腺癌患者术前IVIM参数及DCE-MRI参数与术后复发的关系。同时绘制受试者工作特征(ROC)曲线分析术前IVIM参数、DCE-MRI参数对乳腺癌患者术后复发的预测价值。结果共纳入105例乳腺癌患者,术后随访1年,复发34例,占比32.38%。复发组患者术前Ktrans、Kep高于未复发组,Ve低于未复发组,差异有统计学意义(P<0.05)。复发组患者术前D值低于未复发组,f值、D^(*)值高于未复发组,差异有统计学意义(P<0.05)。经过点二列相关性分析,术前Ktrans、Kep、f值、D^(*)值与乳腺癌患者术后复发呈正相关关系(γ>0,P<0.05);Ve、D值与乳腺癌患者术后复发呈负相关关系(γ<0,P<0.05)。绘制ROC曲线结果显示,Ktrans、Ve、Kep、D值、f值、D^(*)值单独预测乳腺癌患者术后复发的AUC均>0.7,联合预测的AUC>0.9,预测价值更高。结论术前IVIM与DCE-MRI检查对乳腺癌患者改良根治术后复发具有重要的评估价值,IVIM参数联合DCE-MRI定量参数可以作为乳腺癌患者改良根治术后复发的有效预测指标。

深圳地区119例乳腺癌患者术后佩戴义乳现状调查及影响佩戴质量的因素分析

目的:调查深圳地区乳腺癌术后患者的义乳佩戴情况,探讨影响义乳佩戴质量相关因素,为制定有效的护理决策提供依据。方法:通过“汝康云”乳腺癌康复俱乐部平台,采取网络微信调查问卷的形式,对2012年5月至2020年5月期间119例乳腺癌改良根治术后患者佩戴义乳相关认知内容进行调查,并分析调查的结果。结果:79.83%乳腺癌患者知道义乳的存在,52.10%患者有获取义乳佩戴的途径。80.00%的患者认为义乳可以改善形体缺失,达到美观作用;61.05%的患者认为可维持身体平衡;47.37%的患者认为还可保护胸部。半数以上(52.10%)的患者有佩戴义乳的需求,能够接受的义乳价位主要集中在>200~≤500元之间。结论:义乳佩戴的宣传力度不够、患者对义乳作用认识不全、患者对义乳佩戴需求差异可能是影响义乳佩戴的关键因素。

保留肋间臂神经与不保留肋间臂神经对乳腺癌改良根治术患者的影响

目的探讨保留肋间臂神经与不保留肋间臂神经对乳腺癌改良根治术患者的影响。方法根据手术方式的不同将152例乳腺癌改良根治术患者分为切除组(n=71)和保留组(n=81),切除组患者术中不保留肋间臂神经,保留组患者术中保留肋间臂神经。比较两组患者的围手术期指标、上肢感觉障碍发生情况、患侧上肢活动情况以及并发症发生情况。结果两组患者手术时间、术中出血量、淋巴结清扫数目、术后引流管拔除时间、术后住院时间及并发症总发生率比较,差异均无统计学意义(P﹥0.05)。术后1周,两组患者患侧上肢外展、后伸、前屈活动度均小于本组术前,保留组患者患侧上肢外展、后伸、前屈活动度均大于切除组,差异均有统计学意义(P﹤0.05)。保留组患者上肢感觉障碍总发生率为9.88%,低于切除组患者的25.35%,差异有统计学意义(P﹤0.05)。结论保留肋间臂神经与不保留肋间臂神经对乳腺癌改良根治术患者围手术期指标及并发症发生率的影响不大,但保留肋间臂神经对患者术后上肢感觉功能影响更小,患者患侧上肢活动度更大。

优质护理模式在乳腺癌改良根治术后患者中的应用效果

目的探讨优质护理模式在乳腺癌改良根治术后患者中的应用效果。方法回顾性选取2021年7月至2023年6月泰安市肿瘤防治院肿瘤科收治的157例乳腺癌患者为研究对象,根据护理方案的不同分为干预组(75例)和对照组(82例)。干预组采用优质护理方案,对照组采用常规护理方案。比较两组焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量评分及护理总满意率。结果干预后,干预组的SAS、SDS评分低于对照组,差异有统计学意义(P<0.05)。干预后,干预组的功能领域、症状领域和特异性症状评分高于对照组,差异有统计学意义(P<0.05)。干预组护理总满意率高于对照组(P<0.05)。结论优质护理模式能够改善乳腺癌改良根治术后患者的心理状态和生活质量,提高患者满意度。

1例双侧乳腺癌不同术式后保留PICC患者的护理

总结1例行左侧乳腺癌改良根治术、右侧乳房重建术患者成功保留患肢PICC的护理经验。护理重点包括术前多学科评估保留PICC的利弊,制定和实施周密的综合护理方案;加强对症管理、康复锻炼,加强营养支持及心理康复;强化延续护理。结果患者术后住院18 d,切口愈合好,携带PICC出院。出院后继续相关治疗至治疗结束拔除PICC,共留置338 d(入院前留置128 d,住院期间留置85 d,出院后留置125 d),未发生PICC相关并发症。

不同厚度补偿膜对乳腺癌放疗剂量的影响探讨

目的探讨不同厚度补偿膜对乳腺癌放疗剂量的影响。方法选择40例乳腺癌根治术后患者,所有患者均采用三维适形调强放疗技术,靶区包括胸壁和锁骨上区,放疗设计中在胸壁表面先后添加0.5 cm和1.0 cm厚紧贴患者体表的虚拟等效组织补偿膜,比较两种厚度补偿膜时乳腺癌放疗计划中的剂量分布和加速器跳数。结果两种厚度补偿膜时乳腺癌放疗计划中的靶区覆盖率、靶区均匀性指数、靶区最大剂量、靶区最小剂量、靶区平均剂量等剂量参数均无显著差异(P>0.05)。0.5 cm厚度补偿膜时加速器跳数为(113.64±11.73)次,1.0 cm厚度补偿膜时加速器跳数为(125.83±12.52)次,两者比较存在差异(P<0.05)。结论不同厚度补偿膜对乳腺癌放疗计划中的剂量分布无明显影响,但是1.0 cm厚度补偿膜时,可能导致放疗时间和成本增加。因此,在制定放疗计划时,应综合考虑患者情况和资源可用性,选择合适的补偿膜厚度,以达到最佳的放疗效果。